| NPI | 1912296369 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 15775) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: VA 0024170901) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2013-06-28 |